My good friend and colleague S.W. Underwood and myself wrote a piece in response to Dr. Jordan Peterson’s recent comments at the University of Toronto, regarding his refusal to use the pronouns individuals identify with. Please see here for the article!
The Documentary Transgender Kids is available to watch on BBC iPlayer until 30th April 2015 – which can be found here. Apologies if you are outside of the UK and this link doesn’t work.
On the 5th April, Louis Theroux’s latest documentary aired on BBC 2. To quote the BBC’s description of the programme: “Louis travels to San Francisco where medical professionals are helping children with gender dysphoria transition from boy to girl or girl to boy”. Whilst even this is an oversimplification (structuring transgender narratives as always having a binary ‘end result’, and also trans narratives or realities being dependent on gender dysphoric feelings, non-intuitive though this might be for some), the content of the program has been well received.
I agree with Paris Lees when she says that Louis excels at asking questions designed to aid the average viewer’s train of thought in understanding the subject matter. Whilst maintaining his position as ‘guy who doesn’t know much but wants to learn’, he also avoided tired issues of etiquette such as referring to people by the names and pronouns they identify with – as this is easily Google-able, but they moved through this in such a way so that viewers who didn’t already know this kept with the program.
The start of the documentary is strategically important and intelligent. We meet the parents of the little girl Camille, who iterate that their chief concern is doing right by their child, and learning how to best ensure their welfare – a position anyone can get behind. We are also introduced to Diane Ehrensaft who for me, was a highlight of the programme in demonstrating exceptional warmth, sensitivity, and wisdom. One would hope to see Diane’s approach in any professional working to support transgender and gender variant people, but which the voices of the transgender community tell us is sadly not the case.
People with little to no knowledge of transgender often ask the question ‘but how do you know’, and more so in the case of children. The anxiety surrounding the notion of supporting a ‘mistaken’ transition, of the risk of ‘getting it wrong’ is at the front of many people’s minds. It’s a big problem that many people (including medical professionals) can assume that it is ‘safer’ to prevent any kind of gender expression or transition that runs contrary to assignation at birth, because of potential risk. Louis raises this question (at 14.17 in, to be exact). Diane Ehrensaft is worth quoting directly in her response:
Is it a risk? Let’s call it a possibility. So with that possibility then we think, the most important thing is the same exact idea – to find out who you are and make sure you get help, facilitating being that person *then*. We have one risk we know about. The risk to youth when we hold them back, and hold back those interventions – depression, anxiety, suicide attempts, even successes – and if we can facilitate a better life by offering those interventions, I weigh that against there might a possibility that they’ll change later, but they will be alive to change. So that’s how I weigh it on the scales.
Bravo.
It’s also worth mentioning that whilst stopping or reversing transitions does happen, it is comparably rare. These examples shouldn’t need to be ‘hushed up’ because of the fear that they will be used to de-legitimise transgender people’s access to gender affirming services. Indeed one can see that being able to access such things and then stop can also be highly beneficial for an individual, to help work out who they are, and what they want.
The program didn’t make the mistake of trying to make a fictional debate about whether kids should or shouldn’t be given access – it was clearly sympathetic. I felt the show helped lead its audience to accept the importance of this point. It skillfully managed to do this without reducing the transgender voices on the program to one ‘line’ – there were definite differences between the children appearing on the show.
This was perhaps illustrated most clearly by Crystal/Cole, who exhibited a non-binary gender (although the show didn’t name it as such), sometimes expressing herself as Crystal and sometimes as Cole. They broached the fact that for some children (and indeed, plenty of adults as well) gender expression and pronouns could depend upon environment (‘he at school but she at home’) or on time (‘some days I’m Crystal but some days I’m Cole). There are also some conflicts within this particular narrative – Crystal’s mother (at 24.56) says that:
She has said in private with her therapist that she is a girl. Almost 100%. When I’ve sat down and had private conversations with her and said would you ever be interested in [transitioning medically], how do *you* feel about it? And her answer is ‘I can’t do that mommy, I have to be a boy’, and I enquire further as to why and she says ‘because I’m poppy’s only son, and it would destroy poppy’.
This hints heavily at a father who isn’t supportive/understanding/accepting of his child’s gender expression, though we also hear Crystal herself say that she doesn’t prefer one name over the other, and later in the program says she wants to be male when she grows up (though for the very normative reasons of liking the thought of a wife and children, as if one must be male to have this). The show deals with this complexity well, and reflection upon Dr. Ehrensaft’s words are fitting. Crystal/Cole may be a transgender woman who, as a child, is navigating her father socially. They may be a non-binary person, with male and female identities, or some further understanding of themselves may manifest over time. I felt we were invited as an audience to recognise that ‘searching for truth’ is not the point of engaging with transgender people, but the most important factors are respect within the moment, and facilitation of what is needed for happiness and health. Which is not as complicated as critics might make it.
The mainstream media has responded positively to the documentary, although not all the conversations to have come out of it have been positive. For example, BBC Women’s Hour disappointingly attempted to create a very artificial ‘for vs. against’ debate’. Quite rightly, this inspired anger from transgender activist CN Lester, fed up of trans voices and narratives legitimacy being framed as a debate, as if each ‘position’ had equal evidence and importance.
Bottom line – this is a strong and sensitive documentary which I would recommend. Whilst obviously positioned within an American context (and the differences with the healthcare systems are important to consider), many people could learn from the compassion of some of the parents who recognise how important it is to become an advocate for their child. By challenging cisnormativity (the idea that identifying with the gender one is assigned at birth is ‘normal’ or ‘correct’), society is slowly dragged towards being safer and easier for those under the trans umbrella.
Transgender people have, as a group, an enormous amount of awareness of the problems with accessing gender related support through the NHS. This post will highlight some of these problems. Below is a letter received in February 2015 from the Leeds Gender Identity Clinic, copied verbatim (including all errors, down to mis-spacings and grocer’s apostrophes). The quality of this letter is pretty dreadful, and prompted my critique and questions, to be found below the letter.
The numbers in square brackets are references for my points. Some numbers will repeat, indicating the same response to a repeat of a problem.
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Leeds Gender Identity Service
Frequently asked questions August 2013 [1]
Leeds Gender Identity Service is well established, around 20 years old and has evolved over the years. It is a dynamic process. Below are some frequently asked questions and our answers as they stand in 2013.[1]
1) What are the team’s views and commitment to the client group?
The service has a very committed multi disciplinary team. Fortunately all members of the team (Consultant Psychiatrists, Medical Practitioner[2], Endocrinlogist, Clinical Nurse Specialist’s[3], Occupational Therapist, Prescribing Pharmacist, Clinical Team Manager, Clinical Service Manager and the Team Administrators) Share the belief in the bio psycho social model[4] and its application within physical, mental, social and general health and Gender Dysphoria in particular. All members of the team believe in the recognition of Gender Dysphoria[5] and the need to facilitate and co ordinate gender reassignment in the safest and most effective manner.[6]
The service believe in mutual respect between service provider and service user, informed consent, capacity ,[3] guidelines and a flexible application accordingly[3] to individual needs are paramount to the success of an agreed outcome.
2) What standards of care are followed by the service?
The Harry Benjamin International Standards of Care have a well established and historical influence on standards of care which are considered worldwide, over recent times these have evolved into the WPATH, version 7, and standards of care for the health of transsexual, transgender, and gender nonconforming people. As a team we are mindful[7] of this guidance. The team are guided by the National Royal College of Psychiatrist standards; however these have not been ratified[8] are recognised by NHS England. The Gender Act, ICD10, DSM IV, Nice guidelines, Act of parliament 2004 and the policies of the trust including First Do No Harm all guide our practice.
The service has an active involvement in the development of the National standards of care professionals group. This includes other leading, NHS, Gender Identity Services in the UK. The purpose of the group is to define agreed, UK, baseline standards of care.
A proposed DSM V is due for publication; however this is still in draft format.[9]
The DOH[10] published guidance for G.P.’s[3] and other health care staff in May 2013. Leeds Gender Identity Service along with other NHS teams[11] were involved in the preparation of this document.
3) What is included within the care pathway?
The care pathway is guided by the standards of care which are stated above however has the ability to be flexible to meet individual needs. It includes all the stages of Gender reassignment, assessment, hormone treatment, social gender transition and surgery[12]. The service initiates the 2nd opinion and surgical referral but these are completed outside of the Leeds Gender Identity Service[13] therefore any waiting times associated with these are outside of our control.
4) What is the assessment?
The assessment stage takes up to 4 sessions (4 months) however a minimum of 2-3 sessions completed over a 2-3 month period could be agreed according to individual needs.
The criteria of the assessment is confirmation of the diagnosis of gender Dysphoria and exploring aspects of physical, mental and social health. Issues of eligibility and readiness to move into the next stage would be evidence based.
5) What is the social gender transition (SGT)?
Social gender transition is in its entirety approximately 2 years[14]. In order to complete an assessment of social gender transition the information gathered during this stage of social gender transition needs to be evidence based, this would include:
Living in role full time[15]
Change of name[16]
Some form of occupational activity[17] this could include voluntary work, paid employment, further studies or evidence of engagement/ daily living in the new role[18]. The service looks at occupational activity in the most flexible way and will agree with each service user how they will meet this requirement depending on their individual circumstances. If extra support is required by the service user a referral to the occupational therapist is available.
It is the service user[3] responsibility to collect this evidence. The team’s responsibility is to document it [19].
The hormone stage describe3d in question 6 would also fit into the SGT and will last 12months this would include a surgical referral once a positive 2nd opinion has been received.
Leeds Gender Identity Service is keen to learn from our experiences, working safely and flexibly within the care pathway to meet the changing needs of the client group.
For those clients who feel they are unable to live in full time SGT or do not wish to live in role at all in a specified area of their life e.g. employment ‘special circumstances’ this can be discussed with the clinician. If ‘special circumstances’ is agreed the following criteria must be met:
The client will be assessed as fitting the diagnostic criteria of Gender Dysphoria with a high level of confidence[20]. (In accordance with ICD 10)[3]
Psychotherapy opinion / treatment will be accessed and a detailed report provided to the Gender Identity Service supporting a referral for hormone treatment.
A 12 month plan will be agreed if appropriate to identify additional objective evidence for all other aspects of SGT can be ‘agreed between client and clinician.
6) What is involved in the hormone stage?
The service has an appointed Medical Practitioner, Consultant Endocrinologist and a prescribing pharmacist they are responsible for this stage of the pathway. The lead professional remains involved throughout the stages including the hormone stage. Close liaison with General Practitioner[3]/other professionals are a must. This stage could last for 12-18 months or significantly shorter in individual cases. While attending the hormone clinic Clients[3] will receive regular blood test[3] from their GP and blood test monitoring by the gender service, until such a time that it is safe to transfer all hormone treatment care to the GP including appropriate prescriptions.
7) What is the surgical stage?
Surgery stage: 2nd opinion is a prerequisite to a surgical referral. Once we receive a positive 2nd opinion a referral to the appropriate surgeon is initiated. Any delays within this stage would be due to delays in variables[21] totally outside the control of the team.
The service will be responsible for referring clients to an NHS Gender Specialist for a 2nd opinion appointment however if individual clients wish to access private 2nd opinion appointments to speed up waiting times it will be the responsibility of the client to self refer or negotiate[22] this with their GP.
Leeds Gender Identity Service is happy to receive and act upon a positive, private 2nd opinion from a reputable[23] Gender Specialist at the appropriate time within the care pathway.
The service usually refers clients to specific identified surgeons however will consider referral to other areas if a client has a specific request and the CCG[24] are willing to fund surgery in the requested area.
Clients will need to have completed 12months,[3] full time, SGT before receiving a mastectomy and have received 6 months hormone treatment[25].
Breast Augmentation is not currently a core treatment[26] commissioned through Leeds Gender Identity Service; however clients can apply for this following completion of 18 months on hormone treatment[27] if there is clear failure[28] of breast growth. This treatment can be applied for through individual CCG’s via individual funding requests.
On occasions clients have requested orchidectomy surgery without a penectomy, the service will work collaboratively with clients to ensure the treatment provided is in line with supporting client choice and within the safety of clear clinical boundaries.
This would include:
Confirmation from the endocrine clinic that current hormone levels are safe, stable and within range.
And
A ‘one off’ appointment from an independent NHS gender Specialist is obtained.
8) How long will it take me to move through the care pathway?
The service follows a care pathways which can be adapted to individual circumstances taking into account transition which has already taken place before attending the service and specifically for those clients holding a Gender Recognition Certificate. An illustration of the pathway could be represented as follow:
The full process from start to finish around 3-4 years[29]
The shortest flexible process depending on individual needs could be condensed to 18-24 months; this has to be realistic taking into account waiting times for second opinions and surgery which are outside of the services[3] control[30].
9) How do the team keep abreast of new developments and ensure client safety and satisfaction?
The service is part of a wider governance group which include most other UK, NHS Gender Identity Service’s[3]. This group meets on a 6 monthly basis and shares views, takes learning’s[3] and discusses standards and guidelines within the area of Gender Identity.
The team are also part of the Specialist Services Clinical governance group within Leeds and York Partnership NHS Foundation Trust who meet on a quarterly basis and also have a team monthly Clinical Governance meeting where issues can be discussed in more detail. Clinical audits, rigorous clinical supervision, evidence based practice are all essential parts of our practice.
Service user feedback is an area which we have worked particularly hard on over recent years. We always provide clients with feedback forms following any new developments and we also ask service users to complete satisfaction questionnaires. Information taken from these forms is used to develop and inform practice in the service[31].
10) Will I get funding to access the service?
The service is commissioned by NHS England therefore potentially we could accept referrals from around the country. Individuals are funded for assessment and if appropriate core treatments which are funded by NHS England.
11) How will I know what is happening in the service?
The team have a specified lead in service user involvement she works alongside service user volunteers to produce a six monthly newsletter. The Newsletter will update all readers on any new developments within the service, will provide feedback on any completed service user feedback form and how this has informed practice and provide service users with an opportunity to display thoughts, feelings, poems or information to others!
The newsletter is posted out to all service users and is available in the waiting area.
You can also access the News letter via Leeds and York Partnership NHS Foundation Trust website.
12) What if I am discharged from the service but am experiencing a Gender related problem?
The service offers “one off” appointments to clients experiencing an issue they need to explore within the specialist service. To access this you will need support from your GP[22] so they can write to the team and ask us to see you. Again this will be funded by NHS England. The “one off” appointments may cover issues which are stated below:
“One off” assessment lasting for an hour n order to advise GP about outstanding problems and submit a medical (psychiatric) opinion.
A “one off” assessment lasting for an hour carried out by our Medical practitioner who is able to advise GP’s on endocrinology issues.
GP’s can also request “one off” extended full day assessment in complex referrals where specialist advice / recommendations are required.
13) How long will I need to wait to be seen once I have been referred?
The service is commissioned to see a specified number of new clients each year by NHS England[32]. Once we have seen these clients a waiting list will start to form for the next financial year. NHS England are kept informed on the waiting list on a monthly basis and will use this information to help identify new assessments to be funded on each rolling year.
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…And now my bit.
[1] – Well, at least this makes it easy to identify as out of date. Major changes have occurred in the provision of gender based care (such as the release of the DSM V – an important diagnostic tool which actually redefined gender related diagnoses). An update is essential.
[2] – Wait. Only one medical practitioner? For the whole practice? This is alarming not only because of how understaffed it makes the practice appear, but also if any service user has a bad experience with that doctor, there is no-one else. The implication is that access to services all go through this one person.
[3] Grammar is hardly the most important issue here, but when I read an official document providing medical guidance, and it reads as if it was thrown together and not given a second glance, that translates into an uncertainty about the meticulousness and professionalism of the institute being represented. Such primary-school-level errors simply give an unprofessional air, and are easily avoided.
[4] Even with a biology degree I needed Google here, so they could really rephrase to be more user-friendly. How about ‘we understand that personal, social, and psychological factors play a vital part in experiences of gender, and do not seek to reduce service user’s needs to something purely biological’?
[5] – Um. Whilst this is clearly meant to be reassuring, it’s so basic as essential as to come off as alarming at the idea that anyone possibly might not recognise Gender Dysphoria in a Gender Identity Service. If I went to the GP for a vaccination and they said ‘don’t worry, I believe in these!’ I really wouldn’t feel better. There is a history of medical practitioners failing to respect transgender people’s agency, but this statement is hardly an effective way to gain trust.
[6] – I’m so relieved they clarified they wouldn’t do things an unsafe and ineffective manner. Pointless waffle.
[7] – ‘Mindful’ – this is so vague as to be useless. It implies they don’t actually have any external code they’re bound to follow, and can choose to ignore any guidance as and when they see fit. I’m not an alarmist, and I don’t for one minute think guidance would be actively rejected. But not referred to, in preference of one’s own considerations? I can see that happening. Especially as they go on to blanket name six other sets of policies, as if trying to universally appease without actually committing to anything.
[8] – If not ratified, why chosen/used? I couldn’t easily verify whether this has changed since 2013, but practising with unratified standards seems like it requires explanation, at best.
[9] – This is simply out of date. The DSM V has been published, and this is a really important point. The service is potentially then misinforming service users who may not have much knowledge on the topic.
[10] – Explaining what an acronym is when you use it is widely regarded as a good idea – Department of Health. Should also get a [3] tag for not being ‘DoH’.
[11] – If they’re going to say this, they might as well say who.
[12] – This demonstrates how practice is still quite focused on a model of transgender care that emphasises the gender binary, heavily implying ‘one state of being to another’. It of course is fine for individuals who do feel this way about their gender, but is an approach that fails some of those trans people who are most invisible and marginalised within society.
[13] – Why?
[14] – It doesn’t ‘take’ any time at all, because this is an arbitrary and artificial measure created by the medical establishment. This functions as a method of restriction and control, again policing gender identity along arbitrary and binary boundaries. See here, here. and here for some further considerations, though it’s fair to say it’s a point of contention and much discussion, but lacking much research, especially that which emphasises trans voices.
[15] – Further absolutist, binary conception of gender. The very existence of bigender people blows this out of the water.
[16] – If a person is happy with their name, why should they have to change it? Once again ignoring non-binary people, this also ignores unisex names even amongst binary trans people (Alex, Charlie, etc.)!
[17] – The argument for this is to essentially force trans people into being exposed to the world, again to demonstrate a performance of seriousness and sincerity for medical gatekeepers. Whilst this is argued to provide time within which to learn about oneself and gendered practices, it is highly problematic. Not only the danger this puts people in who wish to and may not pass (before being given access to hormones and procedures that can significantly aid in this) but also for those trans people who may experience mental or physical conditions which makes these demands difficult or impossible. The validity of an individual’s gender identity is not dependent upon how that individual is viewed by others in society.
[18] – ‘new vs. old role’ – a dated, binary based requirement and phrasing that doesn’t work for many trans realities.
[19] – And judge what can or can’t count as ‘acceptable’ evidence, which is coloured by binary and cissexist positionality.
[20] – I went into the ICD (International Classification of Diseases) 10. As it was endorsed in 1990, it was no surprise that it still included ‘transsexualism’ and ‘duel-role transvestism’, and used wince-inducing terms like ‘the opposite sex’. There was no obvious mention of ‘confidence levels’ in relation to diagnoses. Therefore what this actually means, I have no idea and I don’t see how anyone else could readily be expected to either.
[21] – ‘Variables’. Nice and vague there. Such as?!
[22] – The expectation to do this is problematic if someone has a GP who is cissexist or transphobic. Which isn’t as rare as one would hope or expect.
[23] – What defines reputable? Obviously this isn’t easy, but such vagueness only serves to emphasise the position of power which the Gender Identity Service occupies. Obviously it’s vital that standards of care are maintained in private practice as well as state funded, but this wording doesn’t help anyone.
[24] – Clinical Commissioning Group. But everyone knows that, apparently.
[25] – No explanation as to why this is. Further relates to problems with the Real Life Test/Social Gender Transition (SGT) as it stands. Fails to account for those trans people who are very knowledgeable, secure, and stable in relation to their needs.
[26] – More unanswered questions. Why? Estrogen does stimulate breast development yes, but frequently produces small or even unnoticeable development. To create a hierarchy of gendered traits/procedures seems inherently nonsensical as what different trans people value and need for their well-being is obviously variable.
[27] – An excessive, arbitrary, and under-justified restriction. Whilst one can appreciate that with change being stimulated by estrogen, an immediate surgery around that time may risk complications, this absolutism runs contrary to the pledge to individual service user needs and desires.
[28] – And a further restriction. Who decides what, and at what size, ‘failed’ breast development is?
[29] – In true cissexist fashion, prioritising the intensely small minority of individuals for whom gender affirmation procedures are not appropriate, to the disproportionate suffering of a very large number of trans people.
[30] – It’s not the first time, but the service has very clearly distanced itself from responsibility for delays. Obviously this is a recurring problem which has invoked complaints and righteous demands for explanations. Are all of these interactions outside of the service strictly necessary? Could the system be made more transparent so that service users can see what aspects of the pathway causes delays? These are questions that trans people deserve answers to.
[31] – Might it be prudent for the service to also engage with transgender groups, so as to get informed guidance from members of the transgender population who aren’t in the (often stressful) process of accessing these services? Of course the feedback from service users is essential, but by no means the only resource available to them for the optimisation of their services.
[32] – This is of particular note. The idea that only a certain number can be seen, in a way that isn’t dictated entirely by resources (as different individuals require different amounts and types of time and care) but is decided upon in advance doesn’t make sense. It also emphasises one of the biggest problems at the heart of the insufficiencies of NHS Gender Identity Services – lack of funding. The number of individuals seeking aid is growing exponentially, and this remains unrecognised by funding bodies. This isn’t a criticism of the document per se, but highlights one of the more important frustrations with the larger system.
Delusions of Gender is an excellent book. From a neuroscientific perspective, Cordelia Fine meticulously unpicks prevalent gender stereotypes we’re all very familiar with, and lays out a detailed and well researched critique of the (often shoddy) research and writings that have propped these beliefs up.
The book is divided into three sections – ‘half changed world, half changed minds’, ‘neurosexism’, and ‘recycling gender’. Whilst I didn’t feel this sectioning was strictly necessary due to how all of the subject material and arguments are interlinked and related, they do help maintain a sense of ‘detailed introduction’, ‘analysis of scientific claims’, ‘detailed conclusion’, which is helpful. I felt that Fine draws the reader in from the start – with pithy, acerbically satirical (but importantly, inoffensive) humour on the very first page of the introduction. By page 9 of the first chapter, one is drawn in by proclamations such as the familiar ‘male/female’ check-boxes at the start of many forms in fact ‘priming gender’ and influencing how one then answers the form. Fine expertly achieves what is necessary for any popular science book – getting people interested in the questions, without scaring them off with the technical aspects. No biological background is needed to appreciate the critiques that Fine structures throughout the book.
I feel the concept of ‘neurosexism’ is a valuable one, which Fine has coined in this work. All too often, the prejudices of researchers can leak into supposedly objective work, because there is a prevalent attitude that scientific methodologies allows researchers to successfully remove themselves from influencing their results, even when undertaking interpretations – rather than recognising the difficulty (and ultimate futility) of this. Little to no acknowledgement of this happens inside or outside of the field, and so one can hopefully see how in combination with the simplistic (but again, virtually ubiquitous) attitude that ‘science = facts’ can cause a lot of problematic stuff to be taken for granted. It is a mighty claim for anyone to say something behavioural is ‘hardwired’, though this is a term I would hazard we are all familiar with through popular culture. Fine uses a great quotation from Anne Fausto-Sterling in the introduction which sums up her claim nicely:
[d]espite the many recent insights of brain research, this organ remains a vast unknown, a perfect medium on which to project, even unwittingly, assumptions about gender.
Throughout the book, an impressively thorough number of references are given (the bibliography is 39 pages long), though in the text there is a recurring focus on the work of a small handful of particular authors. In no particular order, ones that stuck out to me were:
These works were quoted and dissected, used as examples of poor methodology, untenable claims, and problematic stereotype support. What Ben Goldacre might term ‘Bad Science’ (another fabulous book, that you should read if you haven’t, incidentally). The reason I bring this up is because some might claim that the revisiting of these sources may imply there isn’t that much out there to criticise, that Fine may be picking on only a few examples to make her arguments easier to maintain, or to make strawmen of the cases presented.
I do not believe these potential criticisms to stand up, however. Brizendine, Sax, and Baron-Cohen are all respected neurologists, psychologists and doctors (With Allan Pease being the exception, his background being in sales before writing best-sellers on body language and communication with his wife), commanding a great deal of academic clout – making it all the more impressive that Fine’s meticulous research creates serious criticism that also remains accessible. There are a large number of differently sourced examples through the book that highlight how ingrained and accepted much insidious gender stereotyping there is throughout societal consciousness. None of the quotations chosen by Fine of works she casts a critical eye over appear unfairly cherry-picked, and indeed having also read The Essential Difference at least, I can confirm no misrepresentation or simplification of Baron-Cohen’s work, which is almost disappointing as one would not expect a Cambridge Professor to propagate such underdetermined claims that buy into a chronically anti-feminist state of affairs.
Delusions of Gender doesn’t restrict itself to an insular critique of those within the niche of neurobiology. By broadening discussion to how work in this field has influenced (or been influenced by) how people view personal relationships, single/mix sexed schooling, how people raise their children, advertising and media, and work on gendered behaviour in animals, Fine managed to create a work that covers so many important questions as to keep the non-scientist engaged from beginning to end, but without attempting an analysis in terms that are outside her area of familiarity. You won’t find any Judith Butler or Michael Foucault in the references. Nor will you find any meaty discussion of how trans* or non-binary gender experiences are related to the narrative of the science of sex differences. Fine obviously can’t be held responsible for the ubiquity of the sex binary within scientific discourse, though I feel exploration of this could have been a valuable and fascinating addition to the book. It is a delusion of gender to imagine that there are only two genders.
This is tame criticism however for a book that clearly sets out its area of investigation, and does so with precision and originality. I feel it would be a very small number of people who could read this book and honestly say they hadn’t learnt a lot. Make time for this book, even if you think it sounds too brainy.
So at the top of the GenderBen homepage there has been a forlornly empty tab dedicated to book reviews. Today marks the day when this emptiness is no more! This tab will be where links to any book reviews I write can be easily looked up.
It’s probably not normal procedure to open a review with a huge endorsement, but I will be very (and delightfully) surprised if I read any book as thought provoking, clear, useful, and important as this one for quite some time. With the subtitle ‘A Transexual Woman on Sexism and the Scapegoating of Femininity’, Serano utilises structural and stylistic devices in her book that make it a real breath of fresh air compared to many stodgy collections of gender essays and other works useful to scholars of gender.
An incredibly important element of the book which I thought was handled more masterfully than any other gender book I’ve seen was the clarity with which technical terms are used. Also the recognition of the different ways such can be used or understood by different people helps support not only her own robust arguments but also shine a revealing light on the assumptions, misconceptions and prejudices of others.
For example, very early in the book a distinction is made between transphobia, defined by Serano as “an irrational fear of, aversion to, or discrimination against people whose gendered identities, appearances, or behaviors deviate from societal norms.” and cissexism, defined as “the belief that transsexuals’ identified genders are inferior to, or less authentic than, those of cissexuals.” This allows for an analysis that recognises differences in experience based on whether individuals identify as or experience being transsexual as opposed to transgender.
Whilst these are terms that are often used interchangeably (as are cissexism and transphobia), Serano uses the word ‘transsexual’ to refer to individuals who specifically were assigned a given gender at birth, and wish to transition from this (most often referring to MtF and FtM transitions, though appreciation of non-binary identities is also given). Transgender is used as a more general term to allow discussion of issues in a broader sense that may impact upon individuals who may identify as a cross-dresser, as butch, effeminate, queer, or any number of other non-conforming gender identities. The point is made though that “The focus on “transgender” as a one-size-fits-all category for those who “transgress binary gender norms” has inadvertently erased the struggles faced by those of us who lie at the intersection of multiple forms of gender-based prejudice.” Lack of commonality between individuals who may be described by the same terms receives the important attention it deserves. Serano manages to carefully define a large number of gender terms to allow for construction of excellent arguments and observations based on this without simplifying or invisibilising individual experiences as caveats and clarifications are also abound in the text without becoming overwhelming.
The second chapter offers direct commentary on the portrayal of trans individuals in the media, both in fictional and non-fictional circumstances. With films and TV shows covered including The Crying Game, Ace Ventura Pet Detective, Jerry Springer and The Adventures of Priscilla, Queen of the Desert, a perhaps controversially critical analysis is given yet it’s very difficult to fault. The only criticism I have of this section of the book is a small factual inaccuracy made when describing what happens in Ace Ventura. It is claimed that a large group of police officers proceed to vomit after having it revealed to them that the film’s villain who is portrayed as female throughout the film possesses a penis and testicles. They actually all begin spitting – the ‘joke’ being that they have all kissed her at some point, in reference to her having kissed Ace at an earlier point in the film. This hardly makes a huge difference to the nature of the analysis in pointing out unambigous homophobia, and portrayal of a trans individual as ‘deceptive’, and ‘really a man’. The analysis of media output in this chapter rests on trans characters usually falling into one of two patterns, either ‘pathetic’ or ‘deceptive’. Whilst such a binary analysis may seem simplistic, its impressive (and alarming) point is disappointingly supported by a good range of sources cited.
The book repeatedly draws upon the author’s personal experiences, in terms of both how other individuals have responded to her gender identity and gender presentation, but also her direct experiences of dysphoria and ‘gender dissonance’, and the sensation of one’s hormonal profile changing. These accounts are not only very brave (and indeed an honour for the reader – it is a privilege to know the intimate details of an individual’s transition experience), but also tie in important discussion of biological difference to produce an argument that “socialization acts to exaggerate biological gender differences that already exist”. Serano is not only valuably situated as having experienced different gender identities in her life, but also possesses great familiarity with queer theory and the social sciences literature AND a PhD in biochemistry and a scientific career. Such multi-disciplinary scholarship coupled with vital personal experience packs a serious punch. In saying this I of course do not wish to imply that Serano’s PhD and scholarship makes her accounts and arguments on transgender politics and experience superior to the experiences recounted by other trans people. Serano however occupies an uncommon position in possessing such awareness of intersectionality, plus personal understanding of disparate academic and gendered experiences.
The largest chapter in the book is titled “Pathological Science: Debunking Sexological and Sociological Models of Transgenderism”, and gives not only an excellent historical overview but also challenges some methodological problems with scientific modes of inquiry (such as disconnection of the author from work done, or the assumption that some kind of true objective position is actually possible). Discourse on medicalisation, the cissexist declarations made by various feminists, and how masculinity and femininity are considered are tied together in an accessible manner. This leads into a chapter dealing with the dismantling of cissexual privilege which I found provided more clarity and focus than I had achieved through my own introspection, even given that I am actively engaged with trying to be the best ally I can be.
All of this, together with a most original chapter where the appropriation of intersex and transsexual identities in art and academia is critiqued makes up part one of two of this book. The sensation I had from reading each of these two parts was rather different. Part one contained a greater range of material, and had more of an ‘academic’ structure – unsurprising as this half of the book was subtitled ‘Trans/Gender Theory’ – whilst the second section (Trans Women, Femininity, and Feminism) is pithier and contains a greater sense of polemicism. Three of the ten chapters of this section contain only 4 pages each, but each has its place and each makes a point. I had a small sense that some material was repeated, giving me the sense that some chapters were written independently from consideration of the book as a whole, and I felt I gained more from Part 1 than Part 2. This is a book where each chapter stands alone quite well – not quite separate essays, but not a book that necessitates being read linearly from start to finish. Maybe it’s only because I did read it through from start to finish that made me wish for more of a sense of ‘wrapped up conclusion’, but these are ephemeral concerns. In writing this review it was difficult to not write condensed, reworded versions of every chapter, such was the importance of their contents that resonated with me. This book is too important to not be more widely read. One becomes a better human for reading this book.
Things have been a bit serious on GenderBen recently, so I thought, ‘hey, what do a lot of people enjoy looking at on the internet?’
After dismissing porn (because I’ve written about that already of course), I came up with cute fluffy animals.
But how about cute fluffy QUEER animals?
Okay, not really queer. and this has more to do with language and labels than anything else. Being gay, or queer, or any other label you care to mention that provides other people with information about one’s sexual habits says way more about the proclivities of our naughty parts, whether we like it or not. People categorise, and label, and simplify, and stereotype. With animals, all that can really be looked at is what we observe, rather than thoughts and relationships and all that complicated sociological interaction we have as humans. So really, in the realm of scientific study, common practice uses homosexual behaviour to refer to copulation, genital stimulation, mating games, and sexual displays.
It’s also interesting to note that despite animal mating bahaviour obviously having been studied for centuries, it’s only been relatively recently that same-sex-stuff has actually been noticed. This could be due to observer bias – where a scientist’s expectations (“bah, homosexuality only exists in criminal perverts, what”) influence the results of study.
Some of the strategies and behaviours that have been observed are really quite amazing – if not due to cuteness, then due to amusement value.
1. Black Swans
“I told you we needed more than a dab of sunblock on our beaks, but would you listen, no.” “we will talk about it later Cyril, please don’t make a *scene*”
These bad-boy swans have had their sexual capers known about in detail for over 40 years. As gay critters go, they seem to be quite keen on kids. They have been observed to steal nests – or form threesomes with females only to scarper once she lays the eggs. These homo-raised cygnets are also more likely to survive to adulthood, maybe as two males can control a larger territory, or are better at defending their young.
“But mum, Jack’s dads Cyril and Brendon let *him* go swimming…” “I don’t care, you’ve just been blow-dried”
2. Dolphins
I say ‘dolphins’ rather than a specific species because all sorts including the Amazon River dolphin and the Tucuxi, but mostly Bottlenose dolphins seem to enjoy the love that dare not chatter, squeak, or click its name. Not just penetrative sex either. Dolphins have been observed engaging in blowhole sex, the only nasal lovin’ so far seen in the animal kingdom. They’ll also have group sex with genital rubbing, which is thought to be simply for pleasure and bond formation. D’aww. It’s also been recorded that instead of combat, groups of Atlantic Spotted dolphins and Bottlenose dolphins will engage in cross-species romps. Make love, not war, indeed.
3. Bonobos
Speaking of making love not war, this is exactly how the Bonobo has been described by Frans de Waal in his book Bonobo: The Forgotten Ape. It seems that over 75% of sexual acts in the species are non-reproductive, and about 60% are girl-on-girl action. Reasons for this include conflict resolution, post-conflict reconciliation, and simply as a greeting. Practices such as treetop penis-fencing and drop-it-like-it’s-hot rump-rubbing are common.
4. Giraffes
Credit to image: the talented deviant art user Rainbowshrimp.
Male giraffes engage in behaviour called ‘necking’. Unfortunately, this doesn’t involve cute giraffe-hickies. Often it’s combative, swinging their heads like clubs and bashing their necks into each other to establish dominance. It can also be gentle however, with rubbing and leaning. The male who can hold himself erect for longer, wins. The imagery isn’t lost on me. Same sex activity has been recorded at between 30-75%.
5. Sheep
“I’m sorry, I’m just not into ewe…”
From the perspective of husbandry, rams who’re exclusively into other dude-sheep are somewhat problematic, as they make up roughly 10% of the population, and so are no good for making lots of little profitable sheep-babies. A neuroanatomical difference has been found that gives some explanation for this. A chunk of brain called the oSDN is responsible for releasing a substance thought to be involved in the hetero-ram hornification process. This brain region seems to be smaller in homo-rams.
6. Albatrosses
“Darling, I love you.” “I love you too.” “…would you get me a fish?”
Albatrosses are a near-monogamous species, usually pairing with the same bird every year for life (and they can live for up to 70 years). It was in the last 10 years that it was found approximately one-third of paired couples were actually both female, because male and female albatrosses are virtually identical. A detailed account of this discovery and the stir it caused amongst the public can be found here.
7. Bed Bugs
At first I tried to find an image of a real bed bug that also qualified as cute. This it turns out, cannot be done.
So bed bugs it seems will fancy just about any other bed bug, so long as they’ve recently fed, demonstrating good health. Unfortunately, bed bugs perform the violent practice of ‘traumatic insemination’ – where they stab their partner in the abdomen and inject sperm directly in. Females have evolved a structure called a ‘spermalege’, which is basically a ‘damage control’ organ for the rough bug-sex, reducing injury and immune response. Males don’t have this, so it’s not only mildly embarrassing for a dude bug when he accidentally shoves his bug-wang into another dude bug, but also, um, potentially fatal. To try and avoid being unwittingly pronged, males produce alarm hormones. Bed bugs chemically yell “I’M A DUDE, PLEASE DON’T STAB ME WITH YOUR PENIS”.
8. Penguins
Chinstrap penguins (pictured above) gained particular fame due to a pair of penguins called Roy and Silo in Central Park Zoo, who paired and tried to steal eggs from other penguins to rear. Instead they were given an egg, which successfully hatched into a female called Tango – inspiration of the children’s book And Tango Makes Three. Tango herself has apparently paired with a female penguin, and various other same-sex pairings have also been seen. In China, visitors complained to zookeepers for separating a same-sex penguin couple from the other penguins for their egg-stealing attempts. They were given a surplus egg to raise, and were also successful.
So if there’s anything we can learn from this, I suggest it’s that you and me baby, ain’t nothing but mammals, so let’s do it like they do on the discovery channel.
This post is based off a chapter of a book. It’s a rather obscure book called ‘Studies in Ethnomethodology’, which may be among the least catchy possible titles for a book, even given that the chapter was originally published as a paper in 1967. Bear in mind that much of the way in which this story is discussed will be reflecting on attitudes held widely on gender in the 1950s and 1960s.
Don’t give up on me just yet, as the contents are rather unexpectedly fascinating.
The paper was written by one Dr. Garfinkel and his experience treating a patient called Agnes, whom he first met in November of 1958. Agnes had sought medical attention in her home town, been referred to a doctor in Los Angeles, who referred her to a colleague of Dr. Garfinkel who saw her with him.
The nineteen year old Agnes was the youngest of four children, supported by her mother who worked in an aircraft plant. Her father died when Agnes was a child. She was raised Catholic, but no longer believed in God.
These particular sisters may not have put Agnes back on the path to righteousness…
She also had a penis, and testes.
Agnes was presenting with what nowadays would be referred to as an intersex condition – in that she possessed physiology typically associated with the social categories of ‘male’ and ‘female’ at the same time. To quote from Dr. Garfinkel’s account directly:
Agnes’ appearance was convincingly female. She was tall, slim, with a very female shape. Her measurements were 38-25-38. She had long, fine dark-blonde hair, a young face with pretty features, a peaches-and-cream complexion, no facial hair, subtly plucked eyebrows, and no makeup except for lipstick. At the time of her first appearance she was dressed in a tight sweater which marked off her thin shoulders, ample breasts, and narrow waist. Her feet and hands, though somewhat larger than usual for a woman, were in no way remarkable in this respect. Her usual manner of dress did not distinguish her from a typical girl of her age and class. There was nothing garish or exhibitionistic in her attire, nor was there any hint of poor taste or that she was ill at ease in her clothing, as is seen so frequently in transvestites and in women with disturbances in sexual identification. Her voice, pitched at an alto level, was soft, and her delivery had the occasional lisp similar to that affected by feminine appearing male homosexuals. her manner was appropriately feminine with a slight awkwardness that is typical of middle adolescence.
As tempting as it is to pick apart the frankly amazing number of problems there are with anyone, let alone a doctor scrutinising someone in such terms, this isn’t actually the focus of where this is going. Please feel free to pick it apart in your own delicious, juicy minds.
This is a fairly common intersex (and more generally, trans) pride symbol. To think that being intersex is to be a ‘mix’ of male and female (rather than its own state of being, not framed in terms of a binary) as the stereotypical pink-purple-blue colour scheme suggests may be a bit simple.
Agnes wanted to get treatment for what she regarded as a very problematic condition. She thought of her penis and scrotum as being nothing more than a tumour that she wished to have removed so she could get on with living a ‘normal female life’. The fact that she had been born with a penis had meant that for the first 17 years of her life she had been treated and socialised as a boy by her family others who knew her. When she was around 12 years old, she was delighted when she noticed breasts beginning to develop, and other female secondary sex characteristics associated with the onset of puberty.
After much medical scrutiny, it was decided Agnes had a rare disorder known as ‘testicular feminisation syndrome’ , where the testicles, rather than producing testosterone, instead produce lots of oestrogens, causing an XY fetus to develop female genitalia and female traits at puberty. Agnes was seen to be a unique variation on this, in that she had a penis and scrotum and no vagina, and also no ovaries or womb. The doctors were a bit confused by this, but it was the best they could come up with – particularly given how ‘obviously female’ Agnes was to them in all other respects.
Agnes considered herself to be entirely apart from feminine homosexuals, “transvestites” (n.b. I put this in inverted commas because this was the term Dr. Garfinkel and Agnes herself were using at the time to refer to cross-dressers. The term ‘transvestite’ may be considered offensive, and it’s important that this be borne in mind), or any other gender variant individuals, considering them to be “freaks”, and nothing like her whatsoever. She went to an incredible amount of trouble to ensure that she was never scrutinised as being anything other than a ‘normal female’. To again quote directly from Garfinkel’s account:
“I’m not like them” she would continually insist. “In high school I steer clear of boys that acted like sissies … anyone with an abnormal problem … I would completely shy away from them and go to the point of being insulting just enough to get around them … I didn’t want to feel noticed talking to them because somebody might relate them to me. I didn’t want to be classified with them.”
Just as normals frequently will be at a loss to understand “why a person would do that, i.e. engage in homosexual activities or dress as a member of the opposite sex, so did Agnes display the same lack of “understanding” for such behavior, although her accounts characteristically were delivered with flattened affect and never with indignation. When she was invited by me to compare herself with homosexuals and transvestites she found the comparison repulsive.
Agnes was also very anxious about how her situation may affect her relationship with her boyfriend, Bill. Agnes met bill in April of 1958, seven months before she received medical scrutiny. Her refusal to let him allow his hands to wonder below her waist was met with much frustration by him, only temporarily alleviated by claims of her modesty and virginity. Agnes disclosed her situation to him in June, and whilst Bill accepted that it was “like an abnormal growth”, he found it difficult to understand why Agnes attended sessions every Saturday to discuss the condition with the doctors (over 70 hours of interviews were recorded and analysed). This was because Bill did not know that Agnes had been raised as a boy, and she sure as hell wasn’t intending for him to find out. She was also somewhat scared about the fact that Bill might himself be ‘abnormal’ (i.e. homosexual…) due to staying with her after disclosure – though she put this worry to rest after remembering that he took interest in her before he ever knew.
In March 1959, Agnes received a castration operation, where her penis and scrotum were removed, and a vagina constructed in their place. Before the surgery, she was scared that the doctors would make the decision that she was ‘actually’ male, and would amputate her breasts without telling her – but was reassured when told this definitely would not happen. With some time for healing and the use of a penis shaped mould, she was able to acclimatise her new genitals such that she was able to have vaginal sex.
After surgery, Agnes was well accepted by her immediate family and Bill. This was because the doctor’s treatment legitimised her claims of having been ‘female all along’, and that her being raised as male was simply an unhappy mistake due to a condition. The medical justification also meant that her “man-made vagina” was seen as ‘legitimately deserved’ by her, unlike individuals making claims of being women, whilst being ‘unambiguously’ physiologically and genetically ‘male’. Sorry for all the inverted commas, but I hope you see I’m illustrating the beliefs of Agnes and wider society at the time, rather than my own.
PRIDE SHARKTOPUS. I swear, coming up with images to break up the text of this post in a relevant way has been nearly impossible. But I could not resist this badass. For anyone wondering, they’re brandishing the (from bottom left going clockwise): the STRAIGHT ALLY flag, the ASEXUAL flag, the BISEXUAL flag, the PANSEXUAL flag, the GENDERQUEER flag, the INTERSEX flag, the TRANSGENDER flag, and the rather more common LGBT flag. This link is the best I could do towards crediting.
Five years after her surgery and consultation sessions had finished, Agnes returned to catch up with the doctors who had helped her. Whilst she was no longer with Bill, none of the men she had been with sexually since him had ever given any reason to think they found her in any way out of the ordinary. She was still worried however, so Garfinkel arranged for her to see an expert urologist, who confirmed that “her genitalia were quite beyond suspicion”.
Agnes then dropped a massive bombshell.
During the hour following the welcome news given her by the urologist, after having kept it from me for either years, with the greatest casualness, in mid-sentence, and without giving the slightest warning it was coming, she revealed that she had never had a biological defect that had feminised her but that she had been taking estrogens since age 12. In earlier years when talking to me, she had not only said that she had always hoped and expected that when she grew up she would grow into a woman’s body but that starting in puberty this had spontaneously, gradually, but unwaveringly occurred. In contrast, she now revealed that just as puberty began, at the time her voice started to lower and she developed public hair, she began stealing Stilbestrol from her mother, who was taking it on prescription following a panhysterectomy. The child then began filling the prescription on her own, telling the pharmacist that she was picking up the hormone for her mother and paying for it with money taken from her mother’s purse. She did not know what the effects would be, only that this was a female substance, and she had no idea how much to take but more or less tried to follow the amounts her mother took. She kept this up continuously throughout adolescence, and because by chance she had picked just the right time to start taking the hormone, she was able to prevent the development of all secondary sex characteristics that might have been produced by androgens and instead to substitute those produced by estrogens. Nonetheless, the androgens continued to be produced, enough that a normal-sized adult penis developed with capacity for erection and orgasm till sexual excitability was suppressed by age 15. Thus, she became a lovely looking young ‘woman’, though with a normal sized penis…
This 19 year old girl with no medical training, by sheer, unadulterated luck, and using a method that now would be essentially impossible, managed to achieve the treatment and recognition she desired in a time when any gender or sexuality variance was seen near-universally as sickness and/or criminal.
Try reading all that again, bearing in mind what you now know about Agnes. Do you find yourself thinking of her in any way differently? It’s quite amazing how even today, many people still consider legitimacy in gender identity to require the green light from the medical establishment. Agnes’ genius manipulation of the system gives a great big middle finger to anyone who would try and question or prevent her legitimacy. For her, being transgender wasn’t an identity she felt any connection with. She had no interest in waging a political fight, or in challenging any aspect of social norms. There’s no way to really comment on whether her disgust at gender and sexual minorities was an act or real. She got what she needed.
Respect.
The original chapter can be read here (at least in part), through Google books.
One of the most fundamentally obvious things people might think when they’re asked what ‘Gender Studies’ actually is, is that it may look at differences between men and women… in some way. An interesting question to ask might be what actually is it that makes a man ‘a man’ and a woman ‘a woman’? It’s not as obvious as one may think.
When this question was first asked in a legal context (roughly 50 years ago), three factors were used to define ‘biological sex’: the chromosomes of an individual, what gonads (ovaries or testes) they possess, and their genitals. This is overly simplistic as it turns out that many different combinations of these three factors exist than the two categories everyone was assumed (or expected?) to fall into.
The rest of this post will contain science. For anyone apprehensive, I dare you to read on. I double dare you.
We are all told in school that with regards to chromosomes, men = XY and women = XX. For many people this is true. On the Y chromosome, which is a small, stumpy little thing, lies a gene called SRY, which stands for ‘Sex Determining Region Y’. It is responsible for unspecified gonads in a foetus to develop into testes. Seems pretty straightforward. However this area of the Y chromosome can in rare cases cross over to an X chromosome. If this X chromosome is then inherited, an individual who is XX but in all other ways ‘male’ (gonadally, genitally, and in appearance when older) will result. If the SRY-less Y chromosome is inherited, then the foetus will be XY, but otherwise ‘female’. Because sex on a birth certificate is decided just from someone taking a cursory glance, these conditions may be undiagnosed until the age of puberty, or sometimes not at all.
Individuals who possess a SRY gene will develop testes. Testes then produce testosterone, which is responsible for the development of typically male external genital structures (penis and scrotum) and internal genital structures (the bits needed for reproduction inside that aren’t the testicles themselves – mainly specific tubes).
Before sexual differentiation, all foetuses possess two structures where their internal sex organs will be, called the Müllerian and Wolffian structure. Testes produce a substance called ‘Anti-Müllerian Hormone’ (AMH), which causes the Müllerian structure to regress. The testosterone produced by the testes causes the Wolffian structure to develop into male internal structures. Lack of testosterone prevents the Wolffian structure from developing and causes it to regress, and lack of AMH allows the Müllerian structure to develop into ‘female’ parts.
The ‘triggering amount’ of testosterone needed to cause penis and scrotum development is lower than the amount needed to make Wolffian structures develop – so if a foetus has a condition that results in lower levels of testosterone (and there are quite a few that can), the result will be someone without the corresponding male internal organs to match the external ones.
Whilst there are many, many different genetic conditions that can make fitting clearly into a ‘social sex box’† problematic, there are a couple that illustrate the potential ambiguity in defining sex very well.
The first of these is called CAH, or Congenital Adrenal Hyperplasia. This is a mutation in a gene which causes a particular enzyme the body normally produces, to not work. This enzyme is essential for the production of the substance cortisol, and so people with CAH cannot produce cortisol. The result of this is that the hypothalamus (the region of the brain which monitors certain hormone levels among other things) says:
“There is no cortisol! Release precursors!”
Various human brains (paraphrased)
In normal circumstances such precursors would get made into cortisol – but because the enzyme responsible doesn’t work, the precursors end up getting made into testosterone and other ‘masculising’ hormones – giving XX foetuses male genitalia. Due to not actually having testicles, no AMH gets produced, so female internal structures still form. Sometimes the genitals of such individuals are judged to be ‘ambiguous’, and tests are done at birth that reveal the condition. Some however look like entirely unremarkable boys, and may go completely undetected.
Another interesting condition is Androgen Insensitivity Syndrome, AIS. This is a mutation that occurs on the X chromosome, and happens in a gene that encodes a receptor (protein that senses when a particular thing is present) for testosterone. This means that in XY foetuses, even though testes are produced normally, and testosterone is then produced normally – none of the rest of the body can detect that the testosterone is there…so female genitalia develop. AMH is produced which prevents Müllerian structural development, but the Wolffian structures can’t develop either as the testosterone can’t be detected. AIS babies show no signs of being anything but female, though are XY and have testes. There’s no clearly agreed reason or way to decide whether possession of one trait or another is what indicates a foetus or babie’s ‘true’ sex, if such a truth can actually be said to exist.
AIS can be ‘complete’ or ‘partial’, with the ‘partial’ condition resulting in ambiguous genitalia. To quote from the book ‘Brain Gender’ by Melissa Hines:
The direction of sex assignment of individuals with PAIS depends to some extent on the appearance of the external genitalia; those judged to have a penis too small for success in the male role may be surgically feminized and raised as girls, whereas others are reared as boys and treated with andogens to try to stimulate penile enlargement and development of other male secondary sexual characteristics. In this syndrome and others involving undervirilization in XY individuals, however, additional considerations, such as the desire of the parents for a son versus a daughter can also influence the direction of sex assignment.
It’s fair to say that the result of accident or injury resulting in penile loss wouldn’t result in an individual who would be unable to have ‘success in the male role’, regardless of the fact that they have already been raised and socialised as male. This discussion hasn’t even touched on the importance of how personal understanding and identity of one’s gender can reflect on how one is defined. If an individual ‘feels’ strongly that they are a given sex, how is this necessarily any less biological? Whatsmore, is there even reason why choice of identity (particularly beyond the strongly binary male-female that is enforced by much of society) is ‘less valid’ as a way by which sex can be defined? It’s easy to get into some very tricky philosophical areas related to this, and certainly the arenas of biology and socialisation are virtually impossible to disentangle from each other.
When it comes down to it, none of these factors are how people judge the sex of people they see day-to-day. We look at what clothes people wear, their size, build, and where they have hair. We listen to what they sound like, and what their name might be. Most people rarely question what they’re presented with assuming they can easily put a person into one box or another. The questions asking why people feel the need to do this, and why people react the way they do when they can’t, are further huge areas to consider!
†If you’re into that sort of thing.
GenderBen! 